HomeMy WebLinkAboutBuilding Permit 09-0405
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
~ . Z z,. 0,
Date Rec' d
(please type or print and sign at bottom)
I ADDRESS ')J!-t 10 6<J SCl.tvt S t Sw
L White File I PERMIT NO ~
i ~~~w ~;;licant . 0 9. O~I
I ZONING t_=) I
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Pill
OWNER D ' /'_ . ,
(Name) r 0-'" ~ c:l r -e j W I Yl~ Q .,r
(Address) ~;A q ~ 1?~ )S~ VV\ S'-
BUll.DER H C""
(Company Name) . lrYY\ e '- J V\ y- e ) \ -r-C .
(Contact Name) IV\ \ c ~ ell e...
(Address) 'l 0) S. h.Ov"-eDr .
(Phone)
q 5~ -;t 4, -, g tJ- &
A1N S-S ~(l
(phone) 1 (p 3--41 ~ - 4'2 g 10
(Phone)
1 M d'v\ +-h
TYPE OF WORK 0 New Construction DDeck Dporch Re-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: OI.R.C. OI.B.C.
Type of Construction:
Occupancy Group: A B
Division:
I
E
n
F
1
ill IV
H I
2 3
V A
M R
4 5
o Mise:
B
S U
PROJECT COST IV ALUE S
(excluding land)
i. '760
f
I hereby certifY that I have furnished infurmation on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authorized agent for the
above.mentioned property and that all construction will conform to all existing state and local/aws and will proceed in accordance with submitted plans. I am aware that the building
:fficial can ~~. Furthermore, I hereby agree that the city official or a d~~ ~2 ;;;7 to perform needed in17;'5/0 /
I SignatUre Contractor's License No. bate'
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Application Becomes Your Building Permit When Approved
Building Official
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; 1"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
$
This is to certifY that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. 'This document
when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued.
Planning Director
Date Special Conditions, if any
24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372